Don’t say I didn’t tell you, cos I remember talking about this ad infinitum over the last two years. But the medical care you knew and loved is going away. And many reading this are perfectly happy about this, but not baby-boomers retiring to rural areas. Yes, seems that primary care physicians are hard to find in many small towns, and it looks like it may worsen.

Baby-boomers, the 78 million Americans born between 1946 and 1964, could have difficulty finding doctors over the next twenty years. With Medicare cuts proposed targeted under the federal health care overhaul, the shortage is likely to get even worse, said Mark Pauly, professor of health care management at the University of Pennsylvania. Primary care physicians out in rural areas make less per procedure in the Medicare schedule than their city counterparts, and with a cut in the already small reimbursement inherent in the system, doctors are running to the city in droves. Well, no duuuuuuhhhh…….

A 2009 survey of doctors in the Oregon Medical Association showed 19.1 percent of Oregon doctors had closed their practices to Medicare, and 28.1 percent had restricted the numbers of Medicare patients.

The good news is that we knew it was coming, right? Well, there’s at least one solution–Nurse Practitioners (NP). NPs can do medical exams, prescribe some drugs, give shots, take vitals, and so forth…sort of a doctor/nurse hybrid. It’s smart, and I like it. I have worked with a few NPs, and what they can do—their scope—along with their competency, is top-notch. It’s like an all-in-one healthcare practitioner. I have lots of respect for NPs.

Now for you boomers who have decided to retire to rural communities, you may find that you’ll need to pay some things out of pocket. Just come to terms with that: health care is changing, and there’s no need to protest by neglecting your body. I know we all want to get what has been promised to us, and you know what…we just may, in fact, get that…but if for any reason it doesn’t go back to the way it once was, you still need your health. So take care of it, both by participating in health-enhancing behaviors (like seeing a chiropractor–also a primary care doctor, but sans prescription rights), but also by seeing your NP…hey many of them make house calls.

Listen, our old institutions are changing–in some ways for the better (like you taking a proactive approach to your health), and in others for the worse (quality will ultimately suffer, in my opinion). We’ve got to have creative solutions to these new problems–the easiest is to continue taking care of your body. But creating a self-funded medical account will probably be a wise move too.

Awright, good, you knew…just wanted to give a heads up, because new estimates have 40,000 primary care physicians leaving practice within the next decade. That’s how money is saved in a nationalized health system. Reminds me of the time my wife’s esthetician told me that she was a doctor in Russia. “Awesome!” I said. “Not really,” she replied. “Being a doctor there is not like over here, it doesn’t pay much and the hours are long; very few people want to do it.” And now she’s giving facials in Beverly Hills. Nice.

Only 30% of all doctors practice in primary care. If you don’t know, these are the docs that see you first. Don’t know why you’re gassy all day? Primary care physician. Don’t know why your baby toe tingles? Primary care physician. Pissing fire? You get it.

Interestingly, 65 million people currently live in areas designated as having a shortage of primary care physicians, according to the government. But never fear, the new health plan will offer to pay doctors 10% more to serve in those areas. Wow! So if I were to serve in those areas, they’d pay me an additional $3.10 (Medicare pays $31.00 for chiropractic; trust me, it’s my humanitarian gift to society to treat the elderly). Love the government–they sure know how to value a service.

Not only are primary care physicians leaving practice, but when the new health care system takes off in 2014, both the newly insured and existing patients will make a mad rush to doctors’ offices, putting a strain on an already buckling specialty.

No worries, less educated physicians assistants will pick up the slack. They’ll have their government manuals telling them how to handle each condition. Who needs doctors? Differential diagnosis is soooo overated.

I just hope I never see my PCP, Dr. Weiner giving haircuts at the local Fantastic Sams—that’d be awfully embarrassing.

Sick care pushes the seasonal flu shot, which my regular readers might recall has been fingered by experts as inconclusive in its effectiveness. Proponents of health care, on the other hand, myself included, really push upping the vitamin D intake. I think 1,200 IU is pretty good for children, and most adults need much more, like 5,000 IU per day. As we become more aware of the pervasiveness of vitamin D insufficiency in all Americans, including children, getting adequate sunlight and supplementing becomes paramount.

The study conducted at Jikei University School of Medicine, Tokyo showed that children taking the vitamin D supplements were almost half as likely as catching the flu as those taking placebo. And as an added benefit, children taking vitamin D were almost six times less likely to suffer an asthma attack. Holy inhalers! That’s quite a hit to pharmaceutical manufacturers. You mean, that a simple $8 bottle of vitamin D can prevent what a $30.00-$60.00 Albuterol inhaler treats. Well bless my Obamacare–I wonder if vitamin D is covered on the plan.

According to Dr. Adit Ginde, of University of Colorado Denver School of Medicine, who was not involved in the study, told Reuters Health: “This is the first time a study has been done that rigorously shows that vitamin D supplementation can reduce a type of influenza in a dedicated clinical trial.” Ginde and colleagues published a study a year ago showing that asthmatics with lower vitamin D levels were at five times the risk for colds and flu.

Take that, sick care. Another victory in the arena of truth in health. I’ll keep ‘em coming.